Patient monitoring

• Monitor long-term use of high doses if patient is on sodium-restricted diet. (Drug contains sodium.)• Assess for GI bleeding.• Watch for constipation.• With long-term use, monitor blood phosphate level and assess for signs and symptoms of hypophosphatemia (anorexia, malaise, muscle weakness). Also monitor bone density.

Patient teaching

• Tell patient to take drug 1 hour after meals and at bedtime.• Caution patient not to take drug within 1 to 2 hours of anti-infectives, H2 blockers, iron, corticosteroids, or enteric-coated drugs.• Advise patient to take drug with water or fruit juice.• Instruct patient to report signs and symptoms of GI bleeding and hypo-phosphatemia (appetite loss, malaise, muscle weakness).• Recommend increased fiber and fluid intake and regular physical activity to help ease constipation.• Inform patient that drug contains sodium, so he should discuss drug therapy with health care providers if he's later told to consume a low-sodium diet.• Advise patient that he'll need to undergo periodic blood testing and bone mineral density tests if he's receiving long-term therapy.• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

aluminum hydroxide

,

AlternaGEL

(trade name),

Alu-Cap

(trade name),

Alugel

(trade name),

Aluminet

(trade name),

Alu-Tab

(trade name),

Amphojel

(trade name),

Basalgel

(trade name),

Dialume

(trade name)

Classification

Therapeutic: antiulcer agents Pharmacologic: antacids

Pregnancy Category: UK

Indications

Lowering of phosphate levels in patients with chronic renal failure.Adjunctive therapy in the treatment of peptic, duodenal, and gastric ulcers.Hyperacidity, indigestion, reflux esophagitis.

Action

Binds phosphate in the GI tract.

Neutralizes gastric acid and inactivates pepsin.

Therapeutic effects

Lowering of serum phosphate levels.

Healing of ulcers and decreased pain associated with ulcers or gastric hyperacidity.

Constipation limits use alone in the treatment of ulcer disease.

Frequently found in combination with magnesium-containing compounds.

Pharmacokinetics

Absorption: With chronic use, small amounts of aluminum are systemically absorbed.

Distribution: If absorbed, aluminum distributes widely, crosses the placenta, and enters breast milk. Concentrates in the CNS with chronic use.

Metabolism and Excretion: Mostly excreted in feces. Small amounts absorbed are excreted by the kidneys.

Contraindications/Precautions

Adverse Reactions/Side Effects

Gastrointestinal

constipation (most frequent)

Fluid and Electrolyte

hypophosphatemia

Interactions

Drug-Drug interaction

Absorption of tetracyclines, chlorpromazine, iron salts, isoniazid, digoxin, or fluoroquinolones may be decreased.Salicylate blood levels may be decreased.Quinidine, mexiletine, and amphetamine levels may be increased if enough antacid is ingested such that urine pH is increased.

Potential Nursing Diagnoses

Acute pain (Indications)Constipation (Side Effects)

Implementation

Antacids cause premature dissolution and absorption of enteric-coated tablets and may interfere with absorption of other oral medications. Separate administration of aluminum hydroxide and oral medications by at least 1–2 hr.

Tablets must be chewed thoroughly before swallowing to prevent their entering small intestine in undissolved form. Follow with a glass of water.

Shake liquid preparations well before pouring. Follow administration with water to ensure passage into stomach.

Liquid dosage forms are considered more effective than tablets.

Hypophosphatemic: For phosphate lowering, follow dose with full glass of water or fruit juice.

Antacid: May be given in conjunction with magnesium-containing antacids to minimize constipation, except in patients with renal failure. Administer 1 and 3 hr after meals and at bedtime for maximum antacid effect.

For treatment of peptic ulcer, aluminum hydroxide may be administered every 1–2 hr while the patient is awake or diluted with 2–3 parts water and administered intragastrically every 30 min for 12 or more hr per day. Physician may order NG tube clamped after administration.

For reflux esophagitis, administer 15 mL 20–40 min after meals and at bedtime.

Patient/Family Teaching

Instruct patient to take aluminum hydroxide exactly as directed. If on a regular dosing schedule and a dose is missed, take as soon as remembered if not almost time for next dose; do not double doses.

Advise patient not to take aluminum hydroxide within 1–2 hr of other medications without consulting health care professional.

Advise patients to check label for sodium content. Patients with HF or hypertension, or those on sodium restriction, should use low-sodium preparations.

Inform patients of potential for constipation from aluminum hydroxide.

Hypophosphatemia: Patients taking aluminum hydroxide for hyperphosphatemia should be taught the importance of a low-phosphate diet.

Antacid: Caution patient to consult health care professional before taking antacids for more than 2 wk if problem is recurring, if taking other medications, if relief is not obtained, or if symptoms of gastric bleeding (black tarry stools, coffee-ground emesis) occur.

Evaluation/Desired Outcomes

Decrease in serum phosphate levels.

Decrease in GI pain and irritation.

Increase in the pH of gastric secretions. In treatment of peptic ulcer, antacid therapy should be continued for at least 4–6 wk after symptoms have disappeared because there is no correlation between disappearance of symptoms and healing of ulcers.

All content on this website, including dictionary, thesaurus, literature, geography, and other reference data is for informational purposes only. This information should not be considered complete, up to date, and is not intended to be used in place of a visit, consultation, or advice of a legal, medical, or any other professional.